Nose out of joint

On his 14th birthday, he asked for a rhinoplasty. "What's that?" his parents asked. "Surgery to make my nose look better," he said. "No," declared his father. "I had a big nose as a child. It doesn't look so bad now," consoled his mother. But as his friends continued to poke fun at him, he started spending hours in front of the mirror and browsing "nose communities" on the Net.

By the time he went to cosmetic surgeon Anup Dhir of Apollo Indraprastha, Delhi, he had tried it all and failed. He is just another among a multitude of nose-job wannabes who doctors come across every day.

Had Cleopatra's nose been shorter, the history of the world would have been different, they say. But, really, does the nose matter so much? Ask cosmetic surgeons. No one has a better nose for what's inching up the nation's priority list. Young, professional, urban Indians are opting for surgical correction of the shape of the nose in ever increasing numbers, reports the Association of Plastic Surgeons (APS) of India, in the wake of a world congress of plastic, reconstructive and aesthetic surgeons last week in the capital.

"Rhinoplasty is the most popular cosmetic surgery today," says Dr Suresh Gupta, president of the congress. The APS reveals that rhinoplasty has taken a giant leap of nearly 150 per cent in the last five years. That might very well be the tip of the iceberg.

"The demand is much more," feels Dhir. He does about eight surgeries a month, gets 30-35 enquiries from people shopping around for the best price and 40-50 calls from those who are toying with the idea but haven't yet mastered the courage to go under the scalpel.

And they come in all shapes and sizes. On any given day, call in on a plastic surgeon and you will be taken aback by the range of patients filling up their chambers. Dr Narendra Pandya of Mumbai-who has corrected more Bollywood noses than one can count-would typically get a pretty young thing with an impossible list of demands ("I want Aishwarya Rai's bridge, Katrina Kaif's nostrils, Kareena Kapoor's nose tip?").

In Delhi, for Dr Sunil Choudhary, head of aesthetic and reconstructive surgery at Max Healthcare, 70 per cent of the patients are "well-educated, new generation, independent, and most of them are getting it done out of their own pocket".

According to Dr M.S. Venkatesh, head of plastic surgery at the Sagar Apollo Hospital, Bangalore, demand for lunch-time nose jobs from men between age 17 and 28 ("mostly professionals, students and aspiring models") is on the upswing.

"The only thing that's holding me back from feeling good about myself is my nose." Sitting on a stool at the plush Delhi Plastic Surgery Clinic, the young woman inspects her bulging nose in a hand mirror, the high-intensity lamp beating upon the very flat dorsum and very wide alar base. "I don't want to live the rest of my life hating the centre of my face. I am about to enter the real world. I need to look good," she continues. She wants to be an air hostess.

What has changed is not just the numbers, but the rationale behind a nose job. For the longest time, people sought nose corrections to reconstruct a deformed or damaged nose. Way back in 1958, Gupta recalls his first rhinoplasty as a young medic in Agra on a man whose nose had been chopped off by dacoits.

Nose surgery just to improve one's appearance was far out of the mainstream when Pandya set up an aesthetic rhinoplasty practice in Mumbai way back in the 1970s. He remembers facing a storm of criticism from his peer group. All that is history now.

In a new, globalised India, the search for beauty is a socially-sanctioned pastime. And aesthetic considerations have put many an average nose out of joint. "Aesthetic surgery is big all over the world," points out Pandya.

"With rising prosperity, Indians are now very much in sync with their Western counterparts in their penchant for a well-defined nose." Nose jobs top the charts in the West, too. "But there the goal of the procedure is to shorten, tilt or lower a prominent nose. For Indians, this is usually the opposite," he adds.

The most common changes mean making the tip pointed, narrowing the bridge, the wide bony part and nostrils, reducing the base and the angle between nose and lip. The direct inspiration, of course, comes from Bollywood. "Plastic surgery in India began in full-swing in the 1980s as movie stars and fashion icons went for cosmetic surgery," says Pandya.

With it all, the nose has come under attack. "It's the most prominent landmark of your face and virtually dictates your facial expression and personality," says Gupta, who formed the aesthetic surgery unit at Gangaram Hospital five years ago.

A recent survey done by the American Aesthetic Surgery Association reveals that people are more conscious of their face than the rest of their body, as earlier believed. And the nose is the centre of attention on a face. "This explains the rising popularity of the procedure," analyses Choudhary.

This year, Choudhary undertook a study to probe the reasons why patients go in for rhinoplasties. About 30 patients were given a simple questionnaire and the results analysed. "The results show that the two main age groups-those in their 20s and 30s and the 40-plus-have very different reasons and priorities when it comes to nose jobs," he says.

While the bulk of patients in both categories mentioned "to boost self-confidence", it was heavily underscored by the ageing group. For the younger generation, "to increase professional opportunities" and "to attract potential partners" featured prominently, after self-esteem.

It's hard to separate the wheat of "self-esteem" from the chaff of "feel good". And both translate into career success for men, especially in cities and sectors that are linked to the globalised world of work. "Being a part of the global city, a lot of Bangalore men, for instance, want to look and feel young," says Venkatesh.

"They feel good looks are integral to their career growth." The nose has been an area of fascination for the plastic surgeon. "Men with broad, small, slumped or crooked noses appear to have a low self-esteem and end up being less productive in their careers," he adds. A case in point is his patient, Imran Wajid, 24, a Bangalore businessman.

An accidental swing of a cricket bat had left Wajid's nose crooked and made him self-conscious about the way he looked. "The nose job was such a transformation for me that I was jumping with joy when I first saw myself in the mirror," recalls Wajid.

The surge in rhinoplasty demand is matched by the improvement in treatment modalities: from finer suture materials, better understanding of anatomy and physiology, availability of good quality implants to refinement in surgical techniques.

"Previously, the surgeon would access the interior of the nose by making an incision inside the nose, called closed rhinoplasty," says Dhir. Today, surgeon make an incision across the thin strip of tissue that separates the nostrils (open rhinoplasty). "It allows the doctor the least restricted access to lift the skin off the tip of the nose and shape the cartilage precisely."

But plastic surgeons caution that the sophistication of surgical procedures can be disastrous in the hands of unaccredited or unqualified and commercially driven surgeons.

"Rhinoplasty is one of the most difficult cosmetic surgeries today," says Pandya. "It's an extremely intricate procedure where every millimetre counts."

A bad nose job can lead to asymmetries, dissatisfaction, breathing problems and even a collapse of the nasal frame causing a permanent disability. Bollywood actress, Koena Mitra's botched-up nose job which hit the headlines recently, is a case in point says the man who believes that "there are not more than five plastic surgeons in the country competent enough to do a nose job".

There is risk involved even before one goes up to the OT.With peer pressure and penchant for pictureperfect looks, a large number of aspirants come with psychological baggage.

"Very often a plastic surgeon needs to play the role of a psychiatrist," says Gupta. "No surgery is without complication and one has to spend time with patients and understand their psychology."

Dhir categorises the type of patients he tries to avoid: "Those who want a nose like a film star, perceive their 'deformity' to be more than what it is, want to change their nose because their partners want them to, are seriously depressed, incredibly vain or try to hide earlier case/s of a messy nose job."

The bottomline is: a patient has to be realistic and rational. According to plastic surgery literature, the failure rate is 20 per cent while 30 per cent people need revision surgery. "I see a lot of bad nose jobs and it is twice as difficult to correct than a primary nose job," admits Choudhary.

Meantime, the humble nose-often the butt of jokes and rarely taken seriously-is turning out to be a pricey appendage. In every sense of the term. It's now a symbol of agony and ecstasy, of hope and salvation for urban India's upwardly mobile: their chances of marriage and choice of partners, odds of moving up the career ladder or falling face down.

If the threshold for undertaking painful procedures has gone down, the ceiling for spending on feeling and looking good has gone up exponentially. So if you want the nose that you deserve, be ready to shell out anything between Rs 20,000 and Rs 1.5 lakh. In one of Nicolai Gogol's short stories, a nose leaves its owner and develops a life of its own. The current national obsession with the nose seems to be walking up the same path.

-with Stephen David

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